Radical Prostatectomy Versus Stereotactic Radiotherapy for Clinically Localised Prostate Cancer

The PACE-A trial treatment has been a standard of care for almost a year now (except, I think only the original trial sites have probably rolled it out generally so far, and still many sites can't do SABR even thought their LINACs may be technically capable). Two members of one of my support groups have had it over the last 9 months, although they both come under Mount Vernon which has been doing SABR for a long time (they had the first Cyberknife in the UK, well before standard LINACs could do SBRT).

I'm a bit skeptical of using SBRT for all the pelvic lymph nodes - hitting them all with SABR sounds like quite a challenge, but I don't know the trial details.

HDR Boost (standard external beam at reduced dose often including all pelvic lymph nodes, plus a boost of HDR Brachy to the prostate and optionally SV's) has proven very good in this case. There is a trial where the HDR Brachy part is replaced by SBRT, i.e. SBRT to prostate (and SV's for T3b) and standard external beam at a low dose to area where micro-mets may reside just like with HDR Boost. I'm guessing it will be 16 or 23 sessions, like HDR Boost, but I haven't read the trial protocol.

Treating without HT is because the current 5 fraction SABR treatment is only used in cases where no micro-mets are likely. If you have micro-mets in a low dose or no dose area, then you'll need HT to knock them out.

After RARP surgery,then salvage RT to the prostate bed ,I have twice had two separate courses of SABR treatment to two separate pelvic tumors. I didn't have HT with the original SRT, I didn't have any HT with the first  course of SABR treatment and had six months of Bicalutamide with the second course of SABR treatment. Each course was 5 sessions. 

My oncologist did say he suspected I may have metastatic disease before my first PSMA  scan , but that scan did pick up a tumor, so the first SABR treatment was carried out. The same thing happened before the second course of SABR treatment.

The third PSMA scan did not detect a tumor so at this point he more or less says I have micro mets and we await a further rise in my PSA to 3 before another PSMA scan, I assume if that scan detects a tumor it may be treated. It is worth noting I am now being treated privately and the NHS approach may differ.

Are the SABR treatments to the two lymph nodes still classed as salvage treatment or is there a different terminology.

Thanks Chris